Major Challenges of Healthcare Organization Boards

The Major Challenges of Healthcare Organization Boards

Many healthcare provider organizations of all sizes and types have a formal board or advisory governance group of members/trustees. This is especially true if the organization is on the larger side or has significant risk issues to manage. However in this fast-changing healthcare environment, board and trustee chairs and members need to be appropriately selected, operatecohesively as a team and have up-to-date knowledge on what they should be discussing in order to ensure that the organizational mission is on track and the major inherent risks are being properly managed. As a result there are many challenges when not only recruiting a board but then in building the whole board/trustee team into a highly value-adding entity.

Although the challenges are many, research by RX4 Group across over 400 very different healthcare boards in the last 12 months, suggests that the top five for these boards are as follows:
• Poor Staff Selection and matching
• Weak governance/oversight systems
• Little/no vision/strategy
• Board business assessment tools/KPIs/Dashboards
• CEO/Senior leader succession

Lets look at each of these in a little more detail:

Poor Board Member/ Trustee and Senior Staff Selection and Matching
Too many healthcare provider organization boards or groups of trustees are assembled without any kind of selection strategy or tactics, meaning not only that individuals may not make the best possible contribution, but that the team may lack critical skills (especially in functional areas like marketing, operations, human resources or finance). This lack of selection strategy can then extend to CEO and senior staff recruitment, which may fall to the board to control or vet.

Weak governance/oversight systems
Every board or trustee team needs to have a well-structured governance system or control framework that it can use to make sure that major risks are identified and that a system of applicable controls is deployed. The goal here is to make sure that there are no major oversight gaps that may have the potential for future organizational harm or loss of any kind.

Little/no vision/strategy
A Healthcare board’s primary role is to steer the organization in strategic terms. To do this requires a shared and committed “vision” of where the board would like the organization to be at a given point in the future and a high level strategy (usually in the shape of a strategic plan that fully considers the resources needed) in order to get there.

Board business assessment tools/KPIs/Dashboards
To monitor or control the risks to the organization every board needs assessment tools. Although these tools are potentially many and various, it most commonly boils down to a few key performance indicators (KPI’s) or a visual “dashboard” which graphs performance in several major areas that the board deems to be important to control.

CEO/Senior leader succession
Almost all healthcare boards are charged with directly or indirectly hiring the right CEO or Executive Director for their organization. However, they are also responsible for making sure that there is good succession to that role, ideally from within the organization. This means that board members must discuss possible candidates and the competencies he or she will need to succeed and what it will take to “ready” them for the role when the time comes for the person identified to step in.

There are clearly many other challenges that healthcare boards and trustees face but by focusing on these five, overall board performance would improve dramatically. RX4 has experienced all of these challenges in many healthcare provider organizations and can provide considerable insight and options where the knowledge is limited or does not exist internally.

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Dr Jon Warner

Dr. Jon Warner
CEO-RX4 Group-Taking Care of the Business of Healthcare

Jon is the CEO of RX4 Group based in Los Angeles, California. He can be reached at

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